Medicine is based on racial differences that do not exist, says biologist – 03/03/2023 – Ciência Fundamental

In 2011, a review of the Robbins and Cotran Pathologic Basis of Disease, one of the most used pathology books in medical courses, found that, of 31 statements linking African descent to diseases, 17 could not be confirmed by the literature and three were denied. This is one of many examples of the prevalence of false beliefs about racial differences both in teaching and in biomedical practice, the so-called “racialization of medicine”, which results in delays in diagnosis and inadequate treatment.

For evolutionary biologist Joseph Graves Jr., a professor at North Carolina AT&T State University, there is an urgent need to reform medical school curricula and include disciplines with a modern science understanding of human biological diversity, such as biological anthropology. Graves presented at a virtual session of the Annual Meeting of the AAAS (American Association for the Advancement of Science), the largest multidisciplinary scientific society in the world. The meeting, in a hybrid format, began this Thursday, 2nd, in Washington (USA).

“Categories like ‘black’, ‘white’ and ‘Asian’ do not represent genetic differences between groups,” he explained. “Therein lies the biggest racial misconception that persists in the medical community: Socially defined groups continue to be seen as accurate reflections of biological variation in the human species.”

In the 20th century, biological-anthropological and population genetic analyzes conclusively demonstrated that humans do not have biological races, and physical traits such as skin color and craniofacial measurements cannot be used to delineate racial groups. “But the non-existence of biological race does not mean the non-existence of racism,” Graves pointed out.

“It is clear that some adaptations are linked to predisposition to certain diseases – for example, variation in skin color according to latitude [e, consequentemente, a maior ou menor exposição ao sol] may be associated with a predisposition to skin cancer”, continued the biologist. “But knowing that this is true is not the same as relating groups to certain diseases. This needs to be eliminated from medicine.”

For Graves, the connection between socially defined races and disease is rarely neutral. In an article he published in the magazine The New England Journal of Medicine last year with Andrea Deyrup, professor of pathology at Duke University, he cites an association that is often made between keloids and people of African descent.

A study published in 2021, which said that “keloids have been reported in 5% to 16% of individuals of Hispanic and African descent”, did not provide experimental data and relied on a published, but not peer-reviewed, discussion from a 1931 dermatology meeting based on observations of miners in the Congo.

“At that same meeting, however, another researcher reported that a population study of Swiss adults found that 13.3% of them had keloids. The clinical relevance of this disparity (16% vs. 13.3%) is questionable,” the article states. . In October 2021, Deyrup provided the authors of the misguided study with data demonstrating the fragility of the association between race and keloid formation, and the study was partially adjusted.

It is worth mentioning that, to practice medicine in the United States, you must pass an official test, the United States Medical Licensing Examination (USMLE). In 2017, a study analyzed the UWorld Step 1 QBank, one of the most popular USMLE preparatory exams in the country, and verified whether, in questions that brought descriptions of race and ethnicity, these were essential for the correct interpretation of its statements. While the description “white/Caucasian” was central in only 7.4% of the questions, the description “indigenous” was decisive for the “diagnosis” 100% of the time.

“Given the long history of racist assumptions in medicine, ongoing training will be needed to correct generations of misinformation”, says the biologist.

Graves began to reflect on how people thought about race in the 1990s, and has published three books on the subject since then. The last, Racism, Not Race: Answers to Frequently Asked Questions [Racismo, não raça: respostas para perguntas frequentes], co-written with anthropologist Alan H. Goodman and published last year, addresses common misconceptions and dispels the myth of gene-based racial difference. “The inequalities attributed to race are, in fact, caused by racism”, he points out.

Eugenics and statistics

With the theme “science for humanity”, the 2023 AAAS annual meeting – the 189th edition – has part of the program strongly dedicated to discussing topics such as racism, inequalities in academia and ethics in artificial intelligence. At the opening of the event, Gilda Barabino – the second black woman to chair the AAAS in its 175 years – recalled that both the organization and Science magazine (published by AAAS) embraced eugenics in the past, which was recently recognized in an editorial.

One of the virtual sessions on the first day reflected on “how to talk about Ronald Fisher”, one of the founders of statistical science who brought fundamental advances, but who was part of the eugenics movement. In the age of cancellation, the discussion about “controversial geniuses” has been gaining strength on social networks, who, despite having made great contributions to their areas, have biographies stained by histories of racism and sexism.

“Fisher really believed there was a biological basis for the difference in intelligence between human beings, he supported the sterilization of lower classes and encouraged people with ‘better genetics’ to have more children,” said Jana Asher, professor in the Department of Mathematics and Statistics at Slippery Rock University, in the lecture entitled “RA Fisher and Eugenics: How Could a Man So Brilliant Get It So Wrong?”

“People say that Fisher [nascido no fim do século 19] it was a product of its time. Yes and no. Not everyone at the time believed in eugenics.” Asher commented that, when talking about Fisher in his statistics class, he can’t help but remember that he was a human being with flaws and that he didn’t accept that he could be wrong. “To honor him , we need to recognize both their contributions and the harm they caused, on the same level of discussion.”

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Clarice Cudischevitch is a journalist and coordinator of the blog Ciência Fundamental.

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